Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
Department of Medical Ultrasound, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China.
Ultrasound Med Biol. 2024 Nov;50(11):1739-1744. doi: 10.1016/j.ultrasmedbio.2024.08.003. Epub 2024 Aug 23.
To assess the diagnostic efficacy of the CEUS LI-RADS combined with a model constructed on the basis of age, sex, AFP, and PIVKA-II (ASAP) for the diagnosis of HCC in high-risk patients.
This retrospective study included 366 liver lesions from 366 patients who underwent liver CEUS. All liver lesions were characterized and categorized according to CEUS LI-RADS v2017. Two modified methods were applied: LR-3/4/M nodules accompanied by AFP > 200 ng/mL (Criterion 2) or ASAP model score > 0.5256 and CA 19-9 in the normal range (Criterion 3) were recategorized as LR-5. The reference criteria included histopathological or comprehensive imaging and the clinical follow-up results. The diagnostic performance was evaluated and compared by the sensitivity, specificity, PPV, and NPV.
The incidence of HCC in LR-3, LR-4, LR-5, and LR-M was 33.3% (4/12), 86.4% (38/44), 98.5% (191/194) and 82.7% (81/98), respectively. After using Criterion 2 compared to CEUS LI-RADS v2017, the sensitivity of the modified LR-5 for diagnosing HCC increased from 60.8% to 70.7% (p < 0.01) with little effect on its specificity (94.2% vs. 92.3%, p = 1.00) or PPV (98.5% vs. 98.2%, p = 0.86). After using Criterion 3, the sensitivity of the modified LR-5 for the diagnosis of HCC was further improved to 86.9% (p < 0.01), and its specificity and PPV were not significantly changed (92.3% and 98.6%, both p > 0.05).
CEUS LI-RADS combined with the serum biomarker-based ASAP model improved the sensitivity of LR-5 in diagnosing HCC with little effect on its specificity and PPV.
评估 CEUS LI-RADS 联合基于年龄、性别、AFP 和 PIVKA-II（ASAP）的模型对高危患者 HCC 的诊断效能。
本回顾性研究纳入了 366 名接受肝脏 CEUS 检查的患者的 366 个肝脏病变。所有肝脏病变均根据 CEUS LI-RADS v2017 进行特征描述和分类。应用了两种改良方法：伴有 AFP＞200ng/mL（标准 2）或 ASAP 模型评分＞0.5256 且 CA 19-9 处于正常范围（标准 3）的 LR-3/4/M 结节被重新归类为 LR-5。参考标准包括组织病理学或综合影像学及临床随访结果。通过敏感性、特异性、PPV 和 NPV 评估并比较诊断性能。
LR-3、LR-4、LR-5 和 LR-M 中 HCC 的发生率分别为 33.3%（4/12）、86.4%（38/44）、98.5%（191/194）和 82.7%（81/98）。与 CEUS LI-RADS v2017 相比，应用标准 2 后，改良的 LR-5 诊断 HCC 的敏感性从 60.8%提高到 70.7%（p＜0.01），而对其特异性（94.2%比 92.3%，p=1.00）或 PPV（98.5%比 98.2%，p=0.86）影响较小。应用标准 3 后，改良的 LR-5 诊断 HCC 的敏感性进一步提高至 86.9%（p＜0.01），且其特异性和 PPV 无明显变化（92.3%和 98.6%，均 p＞0.05）。
CEUS LI-RADS 联合基于血清标志物的 ASAP 模型提高了 LR-5 诊断 HCC 的敏感性，而对其特异性和 PPV 影响较小。
